DEP/DUA/1/30/24 (Transcript version)

Betty Smart

1783

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Batty Smart. Janr 4^th. 1783

With regard to case of this patient have been & still am very much at loss.

Diffic. however not now [precis.] the same as at first.

For then many doubts respect. nature of affect.

Now chief diffic as to mode of treat.

But before saying any thing of this first necess. to state formr doubts as well as pres. sentim respect nature of disease.

When came under our care, as well indeed as at pres, prin sympt of the hyster. kind.

This affect evid markd, in fits to which she is subj.

Still more in pathognom sympt of Glob. hyster

And may with confid venture to say that hyster. often exists where much less distinct markd.

To be obs. however, that hyster symp often feignd.

And that many female capab. not only capab. of very exact imit of fits but even of induc. real fits when necess.

Hence then incap of judging with cert. even from seeing, still less from merely hearing acct. of fits.

But for doubt in pres. case, an addit. reason occurred.

Affect here referred to a partic [cause]

Obstruct viz of menst. disch.

That this one of most powerful sources of disorder, in female oecon. no one can deny.

At same time often also pretended when does not realy exist.

Or at least when obst. at a period during which should not flow.

That is the state of pregn.

Freq. pretended by females that obst. proceeds from other causes when wish either to conceal pregn. or to procure abort.

Before therefore can with confid employ any powerful means of cure is of utmost conseq. to determ this.

Which however only in gener. to be done by attend to progr. of affect for some length of time.

When this patient however first came under care, from sever. circum, reckond susp. of pregn. not improb.

And this might be cause of Amm whether hyster. feignd or real.

For here, latter disease might proceed from other causes.

And by no means uncomm. to find hyster. sympt in pregn. state.

When first therefore begun treatm now so long ago as begin of Sept. entert great doubts concern. nature of affect.

But if for these susp. there had been any real foundat. pregn. would have been long since distinct. markd.

In four months which have since elapsed would have been indic by obv. sympt.

Now therefore, see little ground for entert. any doubt. concern acct. which she has given us.

And viewing hyster. affect as conseq. of obstruct menst. have little doubt hesitat in consid as exampl of Hyster. Chlor. of Sauv.

At least as far as hyster affect can give name to the disease, to which she is subj.

But here will observe that do not consid hyster as being prim. [diseas]

Has therefore at least equal title to be referrd to G. of Ammenorrh.

And here though pat. only at 17^th year, yet from having already app. at diff. times not strictly Emans. but Suppress. mensi.

A distinct the rather necess in pract. as menses. may at first be obst. from causes never afterw. oper.

Here therefore, following divis of Dr Cullen, might give disease of our patient the name of Ammen. Suppress.

But besides Amm. & Hyst. will [observ] that in hist. of case, a circum ment. still more alarm than either.

But as a short time before selected as subj of lect. for Col. Cas. had been affected with Haemoptys.

And although when case last taken no app. of this kind yet could not vent to say that entirely free from it.

For well known, that from whatever cause it app, very liab to remiss & recurr.

In so much that is only by freq. returns, that is in gener. found to termin in Phthisis.

As having such a termin unquest. to be viewed wherever it app. as an alarm affect.

If therefore to give name to disease from most import. affect complaint to which [patien] subj, should have no hesit in pron. it Haemoptysis.

This disease however very much varied by diff in sex & circum.

And while, always much more danger in males than in females, in latter as arising from diff causes [hav] [very] great diversity in import.

Of all cases, those the least danger which proceed from obst. menses as cause.

In so much that nosol. & pract. writers consid this as distinct the [case]

Here from circum already ment. no doubt in consid pres as an examp. of it.

May consid disease therefore as entit to appellat of Haemopt. catam. of Sauv. – Haemopt. vicaries of Dr Cul.

Upon whole then three diff gener. the charact sympt of which evid in pres. case.

And this circum for my own part have always consid as afford some obj. to mode of invest. by nosol. [illegible] or syst. arrang.

In diff branches of natur hist. botan. for exampl. can never arrive at two conclus.

Any flower which we examine from No of Stamina must belong to a determ & defin. class.

But in diseases, affect may have just title as in pres. case to fall under sever.

For my own part therefore although fully convinced of import & advant of nosol. method, yet hold it to be matter of much greater import. to investig nature than name of a disease.

And this in many cases may at least with some degree of confid be able to accompl. by due attent to causes, comm. & progr of affect.

On this subj. however with regard to pres. case little need now be added.

Is indeed unacq. with any partic cause to which obst. of menses can be ascribd.

But this we are told was the first of her compl.

And for my own part, now little hesitat in adopt her opin, that is the origin to which all of them to be traced.

With this view then of nature of affect next to speak of prognos.

And here must own by no means without appreh.

Some of compl. of patient indeed much more alarm than danger.

Ammenorh. in every inst. fatal only by its conseq.

And hitherto at least, few of those sympt. have taken place, tenden of which most cert. fatal.

Such for examp. as hydrop affect from evidently markd chloros.

Hyster sympt. here the chief [which] take place although alarm yet very gener. far from danger.

And even Haemopty. as have already obs, much less alarm with females, & when proceeds from Ammen. than in any other situat.

Yet by contin of all these can be little doubt that constit must suffer very consid.

And although at pres. no partic indic of either, yet would be by no means extraord. if in short time should termin either in Phth. or Drop.

The rather to be appreh, as little immed prosp. of cure of affect.

For have already, without effect, employd sever remed, from which I own more hopes of success than from any pract. to which can now [have] recourse.

Restorat of menst. disch, also by operat of syst. itself, now much less to be expected, than if disease were in incip. state.

Has already contin for sever month

And well known that tenden. to return dimin in prop. to length of time for which wanting.

Besides this no reason to expect that soon any remark change on [sys] of uterus with patient.

Such for ex. as that of pregn or the like.

And may here obs. that should consid chance of recov. as better, if married than when single.

May also add that danger encreasd by age.

For is at pres, at that period of life, when tend to consumpt, unquest strongest.

But although from these circum ground for appreh, yet disease can by no means be repres. as in desper. situat.

Without restorat of menst. disch. [inded], cannot expect compl. remov. eithr of hyster affect, or prevent of return of haemorrh, by lungs.

Yet both may be moder, & influ on syst. counteracted.

Hence then even with contin of Ammenorh. may not only prevent increase but even obt. mitig of affects

But besides this, restorat of menst disch one of those partic in oecon. concerning which great uncert.

Still much uncertainty both with regard to prin on which disch proceeds & to causes of obstruct.

Hence then where pract app. [best] accom. fail, others seemingly much less so, will sometimes succeed.

Nay disch will often spon. return, when entirely at loss from what cause it proceeds.

Thus not altog without expect, that in this mannr, compl. remov. of all sympt. may suddenly take place.

These then suffic to encouragem to trial of diff pract.

And with view to all differ affect to which patient subj, many which may be employd.

Yet must own very much at loss to determ which can be used with great [pos] of [success]

Accord since commen of case under our care have already tried diff pract.

After reason to inferr that susp of pregn groundless, endeav chiefly directd to restor of menst. flux.

Want of this disch. may proceed from very various causes.

But appreh that all of them ultim operate on one of three prin.

Either depend on want of due accum of blood in uterus.

Want of due action of that [viscus] after blood is accum.

Or uncomm obstr. to passages through which should natur. make its way.

In case before us, saw no circum which could give presumpt eithr of first or of last.

As patient had already regul [menses] for sever periods, cert. evid that no [unsurm] obstr. depend on struct of parts.

As manif tenden. to vicar haemorr occurring under form of hymoptysis had at least evid that no want of blood in gener. sympt.

While at same time sympt [preced] haemopt. such as gave presumpt even of due accum in uterine vessels.

From these circum then inclind to concl. that Amen. here proceeded from want of due action of uterus after accum. there had taken place.

And this suppos. seemd to be corrob. by constit of patient.

Partic by fair [counten] delicacy of habit & hystr. compl.

From these consid then conclude that disch. would most readily be restored, by giving uterus due, [power] of action.

That is by encreasing tone either from action on uterus itself, or on system in gener.

On this ground will understand why had recourse to first remed, mentiond in hist of case use viz of Chalyb.

These well known, to be among more powerful tonics, which possess.

Hence few remed more freq. in use both in Amm & Hyster.

And will partic observe, that strongly recomm by Mr Sauv. in Hyster. Chlo. one of the names, which have obs. applic, to affect of pres. pat.

Here as one of best chaly. with much acq. empl. Rubig. Ferri.

This exhib as united with powdr of Valer.

Here added in some degree with intent of giving prop. formula.

But still more from hopes that might be conduc. in allay. inord [illegible]

For have no doubt that in certain circum, from impress which gives to stom. has in this way powerful influence.

That thus effect on Nerv. energy very great, no one can deny who has ever witnessd its influ on Cats.

And indeed with them, a remedy to which directed by inst. for counteracts nervous diseases to which liab.

On these grounds then expected some advant from prop. trial of this remedy.

But after such a trial made, found expect. disapp.

After this therfore had recourse to anoth pract. which reckon still more powerful in Ammen.

Use viz of Electricity.

Of all emmen. yet introd into pract this in my opin the most powerful.

Partic where Amm. depends on want of due action of uterus.

Here I appreh. operat to be expl. in two ways.

Sometimes has effect of induc imm action.

Sometimes of restor power of action where lost or dimin.

Influence in latter of these ways exempl. in restor power of motion to paralyt. limbs.

On formr again, have evid of effect influ by convuls. motion which excites, in musc. of an anim app. dead, & with whom all other stim cease to have effect.

Thus then can I think readily unders. why should be a powerf. remed in Amm.

And accord. utilit in that affect now fully conf. by public on the subj by Dr Saund. Mr [Birch] & many others

And remedy itself daily use with most pract. in this country.

Hence then even after chalyb. had faild entert. expect of benef. from use.

But in pres. case, a circum occurd, by which prev. from, giving it fair trial.

Though elect. ordered to be employd in gentle manner had here a very [pecu] effect.

Pat. const. found herself much [weakn] after coming from the wheel.

And this weakn. to such extent even as to give tend to deliq. animi.

These circum am disp to attrib not so much to elect. as to fear [which] pat. had been under.

For well known that even with the robust & vigor. Electri [to] some indiv gives pecul. & with some very distress. sensat.

Hence then will hardly perhaps seem surpriz. that with irrit & hyst female, should induce weakn & even tend to deliq.

Yet must view this effect as somewhat singul from having never before met with it.

And that too although have freq. empl. hyst. with females of most timor & irrit habits.

Hoped the rather therfore, that this uneas. from slight habit might go off.

But feelings of patient, for space of eight days, cont. so distress. to her, that determ for pres. at least, to [illegible] use.

After trial therfore for eight days, during which time had no influ in restor disch, was omitted.

Besides these, before selected as subj of pract. at Col. Cas, some other remed also tried.

But these prin intended for obv. such urgent sympt. as have at times occurrd.

After receivd as pat at Col. Cas. first pract. to which had recourse was Calc of Zinc.

Of this remed in treat of case of Arabella Wallace had very lately occas to speak.

May here only repeat, that since introd by Dr Gaub. have freq. empl it & [any] think with remark advant.

Here intent with which cheifly used was with view of obt. effects of Tonic.

In this manner as well as chaly expected that might be means of restr. menses

But had still greatr expect. from influ as counteract. hyster affect.

In this way have often I think seen good effects from it.

And if this could be counteracted hoped that restorat of menses might more readily follow from operat of syst. itself.

For no doubt that those inordin actions which take place in hystr. freq. effect of checking disch.

After due trial of Zinc however have been disapp.

And have deserted use as inadeq to remov. either of Hyster or Amm in pres. inst.

During empl. of Zinc. other pract sometimes introd with view of [obv] [sym]

Partic with view of moving belly. And to be obs. that tend. to costiv often remark great.

Was with this view that had recourse to Pil. Foetid cum Aloe.

These at first even in small dose had effect of induc sever. loose stools.

But afterwards so far lost influ. that subsit to them the Pulv [Jallap] comp.

From this even to quant of half a dram only obt. wishd for effect.

But at last report found that had been affected with some return of bloody expect.

In this situat wishd to avoid the stimul. effects of Jallap.

Have therfore directed, with view of moving belly Crem of Tart without any Jallap.

And as means of counteract hyster sympt partic palpit have have advised use of Tinct. Fulig.

At pres. however directed only in small dose

And if no inconv from use may prob. try effects to greater extent.

But from this I own have best little expectat.

And must also add that now very much at loss what pract to direct with much prospect of success.

When however pres. haemopt has ceased have thoughts of making trial here of the Rub. Tinct.

If succeeds will be by much strongest case that I have yet met with in fav of the med.

If fails, will be no more than has already happ. to other Emm. & therfore no ground for concl. against it.

If disap from Rubia have some thoughts of trying a pract very oppos. to course hitherto followed

Use viz of Warm Bathing or at least [illegible] conj with Opium.

Partic empl. these at period when reason to expect tend to flow.

If this shall fail, will prob. have recourse to trial of other tonics

Partic Peruv. Bark & when the season will permit of it Cold Bathin

But in these must be very much directed by circum.

And if are empl. shall prob. afterwards state opin with respect to them at more length.